As of October 23, only 15 hospitals in the US have adopted the new rural emergency hospital (REH) designation, with 10 of them situated in Republican-leaning states that rejected Medicaid expansion. This choice stems from the REH's requirement to relinquish inpatient services in exchange for increased government reimbursements. Some hospitals remain hopeful, while others seek program improvements, such as eligibility for the federal 340B drug discount plan.